66-70 Gy : gross tumor volume + isotropic expansion of 5 mm. ; CTV 59.4-60 Gy: lymph node regions (LNR) at high risk;. CTV50.4-54 Gy: LNR at low risk.
S626 66-70 Gy : gross tumor volume + isotropic expansion of 5 mm ; CTV 59.4-60 Gy: lymph node regions (LNR) at high risk; CTV50.4-54 Gy: LNR at low risk. PTV were developed by adding to CTV an isotropic expansion of 5 mm. Patients with II stage NPC were treated with concurrent CHRT and patient with III-IVA/B stage were treated with neoadjuvant CHT followed by concurrent CHRT. Acute and late toxicities were graded according to Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer radiation morbidity scoring criteria. Results: We retrospectively analyzed 53 patients (pts) with pathologically diagnosed NPC, including 37 males and 16 females; mean age was 52.8 years (range 14-77 years). According to the AJCC 2010 staging system 8 pts had II stage, 30 pts III stage and 15 pts IVA/B stage. At a median follow-up of 26 months, 13 pts experienced local regional failure and distant metastasis occurred in 11 pts. Reirradiation +/chemotherapy were used as salvage treatment in 6 pts, chemotherapy in 2 pts and 2 other pts received surgery (in 1 pt lymph node dissection and the other pulmonary metastasectomy). The 2 years actuarial loco-regional failure– free survival and disease free survival were 78.9 % and 78.4 %, respectively. No patients had treatment failure after 24 months.
No grade > 4 acute toxicity and no > 3 late toxicity were observed. Conclusions: IMRT- SIB combined with concurrent chemotherapy +/- neoadjuvant CHT resulted in encouraging rates of local regional control with acceptable rates of acute and late side effects in patients with locoregionally advanced NPC. EP-1152 Induction chemotherapy followed by radiochemotherapy versus radiochemotherapy alone in nasopharyngeal cancer R. Autorino1, N. Dinapoli1, F. Miccichè1, F. Bussu2, M. Balducci1, C. Parrilla2, J. Galli2, G. Almadori2, G. Paludetti2, V. Valentini1 1 Università Cattolica Sacro Cuore Rome, Radiation Oncology Department Gemelli ART, Rome, Italy 2 Università Cattolica Sacro Cuore Rome, Otorhinolaryngology, Rome, Italy Purpose/Objective: To evaluate the efficacy and toxicity of induction chemotherapy (IC) followed by radiochemotherapy (RTCT) versus concurrent radiochemotherapy for locoregionally advanced nasopharyngeal cancer (NPC).
3rd ESTRO Forum 2015 Materials and Methods: Patients with locoregionally advanced NPC were treated with three cycles of induction chemotherapy (IC) with Taxotere (75 mg/m2) plus cisplatin (75 mg/m2), plus 5-Fluoruracil (750 mg/m2) followed by full doses of IMRT (70 Gy) concurrently with cisplatin 100 mg/m(2) every 21 days for three cycles (Group A) or to the same RTCT regimen alone (Group B). The outcomes of patients was evaluated in terms of overall survival (OS), local control (LC), and toxicity. Results: From July 2007 until December 2013, 45 patients were analyzed. Among them, 23 patients received three cycles of IC and 22 patients were treated with concomitant radiochemotherapy alone. With a median follow-up of 63 months for the entire group, (range 3-146), 1-ys, 3-ys and 5ys Overall Survival were 79%, 58% and 52% for patients treated with induction chemotherapy, and 95%, 89% and 81% for RTCT alone, respectively (p=0.04). One-year, 3-ys and 5ys Disease Free-Survival were 64%, 41% and 19% for patients undergone to IC, 88%, 81% and 65% for patients receiving RTCT alone (p=0.0020). Patients undergone to radiochemotherapy alone had a significantly higher local control than patients treated with IC (3-ys LC: 97% vs 40%: p= 0.0014). The stage affect the final multivariate model for OS (p=0.03), and DFS (p=0.0021) and LC (p=0.0086). Acute toxicity was similar in both groups. Conclusions: Compared with the induction chemotherapy group, concurrent chemoradiotherapy alone could significantly improve prognosis in terms of overall survival, loco-regional failure-free survival, even if patients treated with neoadjuvant chemotherapy had a very locally advanced disease. However, distant metastatic events still remain a problem, and larger and multicenter randomized trials are required to assess whether IC followed by RTCT is superior to RTCT alone. EP-1153 Nasopharyngeal carcinoma treated with intensitymodulated radiotherapy in a non-endemic area H. Letelier1, A. Lozano2, A. Navarro2, R. Mesía3, S. Vásquez3, V. Navarro2, M. Mañós4, R. De Blas5, F. Guedea2 1 Universidad de Valparaiso, Oncología Radioterápica, Valparaiso, Chile 2 Institut Catala d'Oncologia, Oncología Radioterápica, Barcelona, Spain 3 Institut Catala d'Oncologia, Oncología Médica, Barcelona, Spain 4 Hospital Universitario de Bellvitge, Otorrinolaringologia, Barcelona, Spain 5 Institut Catala d'Oncologia, Física Médica y Protección Radiológica, Barcelona, Spain Purpose/Objective: Despite the numerous retrospective and prospective series about IMRT treatment of Nasopharyngeal Carcinoma (NPC) in the literature, there is not a clear consensus in dose schemes and target volume definitions. Furthermore, there are few studies about non-Asiatic populations, with small data on European countries. The aim of this study is to describe and analyze our results in treating all-stages NPC with IMRT-simultaneous integrated boost (SIB), in a non-endemic area. Materials and Methods: We performed a retrospective review of 52 consecutive patients with NPC treated with curative intention with IMRT-SIB in our institution between
3rd ESTRO Forum 2015 2007 and 2013. Patients with incomplete data and without follow up before treatment, were excluded. All patients received the same RT scheme: 33 daily fractions of 1.64 Gy to intermediate-risk volume and 2.12 Gy to high-risk volume with SIB, reaching 54.12 Gy and 69.96 Gy respectively. Descriptive statistics (frequencies and percentages) were used to report the characteristics of patients, their clinical status, the treatment performed and toxicities reported. The oncologic outcomes were overall survival (OS), loco-regional relapse-free survival (LRRFS), metastases-free survival (MFS) and progression free survival (PFS). These variables were estimated using the Kaplan-Meier method (95% CI level). Results: The median follow-up was 28.1 months. Median age was 49 years (range, 15 - 78). There was a predominance of men (67.3%), white race (80.8%). The tumors were undifferentiated (WHO III) in 40 patients (76.9%), and EBV positive in 33 (63.5%). There was a majority of locally advanced disease, with 48 patients (92.3%) stage III-IV. Only 5 patients (9.6%) were treated exclusively with RT, while the rest received chemotherapy (CT), mainly concurrent (84.6%). Neoadjuvant CT was delivered to 22 (42.3%) patients, adjuvant CT to 4 (7.7%) patients and 15 (28.8%) patients received neoadjuvant and adjuvant CT. The 1- and 3-year estimation of OS was 98.0% and 85.5%, respectively, while 1 and 3-year LRRFS were 100% and 95.8%, respectively. Conclusions: The treatment of NPC (predominantly locally advanced) using IMRT-SIB in our institution, offers a rational and feasible alternative of treatment, comparable to results described so far in endemic population. EP-1154 Nasopharyngeal carcinoma in a non endemic country: results of a single institution on 187 consecutive patients S. Tonoli1, R. Cavagnini1, S. Ciccarelli1, M. Maddalo1, F. Foscarini1, N. Pasinetti1, L. Costa1, S.M. Magrini1 1 Spedali Civili di Brescia, Radiotherapy, Brescia, Italy Purpose/Objective: To analyse the outcome of all the patients treated in our Institute for Nasopharyngeal Carcinoma without distant metastasis at diagnosis in a period of 14 years. Materials and Methods: From January 2000 to December 2013 187 consecutive patients received radiotherapy +/chemotherapy (neoadjuvant and/or concomitant). Results: According to TNM classification, UICC 2009, 31% of patients were in stage I-II, 69% in stage III-Iva-b. The predominant histologic pattern was WHO type 3 in 70.6% of patients. At 10 years Overall Survival (OS) has been 65+/-6%, Disease Specific Survival (DSS) 82+/-3%, Loco Regional Control (LRC) 73+/-5%, Distant Metastasis Free Survival (DMFS) 63+/5%. Many clinical variables (gender, histology, age, T and N classification, Stage, Karnofski index) and others related to treatment (chemotherapy, waiting time from histological diagnosis to first treatment, prolongation of overall radiation treatment time, technique of treatment - 3DCRT vs IMRT-, fractionation), have been analyzed.At univariate analysis OS was statistically related to T and N class, clinical stage, Karnofski index, concomitant chemotherapy, respect of overall treatment time, modality of irradiation. LRC was related to T class, clinical stage, chemotherapy, use of IMRT and fractionation (2.3 Gy/fr vs 2 Gy/fr). The DMFS resulted related to T class, clinical stage, chemotherapy and time
S627 between the start of neoadjuvant chemotherapy and radiotherapy. At multivariate analysis, the statistically significant factors at univariate analysis were considered. For OS the final model maintained T class, stage, age, and chemotherapy. LRC was related with stage, chemotherapy and the use of IMRT. DMFS resulted related to the time between start of neoadjuvant chemotherapy and the start of radiotherapy (worse results for length of time superior to 30 days). Conclusions: In our single experience the introduction of IMRT, frequently associated with IGRT, has been associated with a sharp improvement of LRC at 5 yrs (88+/-4% with IMRT vs 64+/-7% with 3DCRT, p 0.010), even if we consider the association with chemotherapy in various modality (neoadjuvant chemo followed by RTT alone or RTT/chemo, exclusive radio-chemotherapy or radiotherapy alone). Other variables could be involved in this improvement, such as a better local definition with MR co-registration during planning in the last years, or a better staging with the frequent use of CT-PET which can identify cases with distant metastasis at first diagnosis. The gain obtained with IMRT was also evident in an improvement in OS (82+/-5% vs 70+/-5% at 5 yrs, p 0.038) while no differences were found in DMFS. The analysis is still in progress. EP-1155 Analysis of loco-regional failures in head and neck cancer after intensity-modulated radiation therapy F. De Felice1, C. Thomas2, S. Barrington3, Y. Suh4, L. Pike3, M. Lei4, T. GuerreroUrbano4 1 Guy's and St Thomas' NHS Foundation Trust London UK Policlinico Umberto I “Sapienza” University of Rome, Department of Clinical Oncology and Radiotherapy, Roma, Italy 2 Guy's and St Thomas' NHS Foundation Trust London UK, Department of Medical Physics, London, United Kingdom 3 Guy's and St Thomas' NHS Foundation Trust London UK, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom 4 Guy's and St Thomas' NHS Foundation Trust London UK, Department of Clinical Oncology, London, United Kingdom Purpose/Objective: To investigate the correlation between location of loco-regional failures and previous intensitymodulated radiation therapy (IMRT) target volumes in patients with head and neck (H&N) cancer. Materials and Methods: 65 consecutive patients (44 men; mean age 59.8 years) presenting with biopsy proven failure between May 2011 and April 2014 were retrospectively reviewed. Primary tumour location was nasopharynx (n = 4), oropharynx (n = 23), oral cavity (n = 11), hypopharynx (n = 4), larynx (n = 15), salivary gland (n = 1), primary unknown (n= 1), and sinus (n = 6). Forty-eight patients had primary and 17 post-operative (chemo)IMRT. Primary radical doses of 6570Gy and 54-56 Gy (30-35 fractions) were delivered to high dose (PTV1) and prophylactic (PTV2) target volumes, respectively, using a SIB-IMRT technique. In the postoperative setting the dose to PTV1 was 60-66 Gy (30-33 fractions). The sites of loco-regional failure (persistent or recurrent disease) were delineated on the diagnostic FDGPET-CT or CT scans which were co-registered with RT
